PISCES III Intake Questionnaire



Thank you for your interest in the PISCES III study. The purpose of this questionnaire is to help determine if you may be eligible for further pre-screening to participate in the PISCES III study.  This is the type of information we will collect and store about you in this questionnaire:
Name and contact information
Stroke information, including any remaining disabilities, and other simple questions related to your medical history


The data you provide will be digitally stored on behalf of the research project in the United States in a HIPAA compliant data center and/or on a highly secured server at Duke University Health System in the United States.  Anonymized data relating to your pre-screening answers will be shared with the sponsor of this study (ReNeuron), who is located in the UK.  You may modify or have the data removed at any time by calling us at [call center callback number] and we can assist you.  You can also view our privacy policy any time at Privacy Policy.
Call the PISCES III team at 1-844-707-8336
Email the PISCES III team at PISCES3@duke.edu



By clicking on the “Yes I Agree” button below you consent to participate in the PISCES III Intake Questionnaire as detailed above. If you do not wish to participate please click the “No I Disagree” button. You may stop the registration process at any time. If you choose to stop, we will not use any of the information you have provided.
(Registration takes approximately 10 minutes to complete.)